Bill Gates is Wrong

Bill Gates has suggested that the Millennium Development Goals do not need updating. He is wrong; here’s why:

Throughout the world, from Burma to Namibia, Somaliland to Laos, China to Nicaragua, there are communities of people marginalised by the societies in which they live and forgotten by international development organisations. For many of these communities, the Millennium Development Goals (MDGs) have done nothing to improve their situation, and may even have made it worse.

The MDGs are rightly recognised for increasing the overall resources and political energy focused on battling some of the effects of poverty.  However they are flawed. They have not led to the prioritisation of the poorest and most marginalised communities; they may in fact have led to a situation in which resources have been diverted away from these groups of people.

The MDGs focus on aggregate, numerical targets for reducing poverty. This has led to a concentration on reaching the largest numbers of people rather than the most vulnerable, which has all too frequently translated into the easiest to reach, often urban populations or mainstream groups.

If you were tasked with saving the lives of two thirds of the children under five in the country you live in, with extremely limited resources, would you choose to focus on the ones in the capital city near the existing hospitals or the ones living deep in the rainforest whose lives would take considerably more resources to save?

This is the kind of choice governments are forced to make by the development goals in their current form.  But All children, wherever they live, deserve the best chance at life and good health.

The focus on overall targets, rather than on equity and reaching the most vulnerable, has meant there has not been a concerted effort to improve the health and lives of many groups of people.

The focus on aggregate figures also means that the most marginalised groups are not only neglected in terms of resources, but also in terms of monitoring and analysis. Because the success of the goals is only measured at the aggregate level, data on health and poverty collected locally is not broken down by ethnicity. This means there is extremely limited information on how much certain populations have actually been affected by the development efforts of the last decade.  The average figure might have improved, while hiding extreme pockets of poverty where things have got worse.

We now have the opportunity to rectify the problem. Future goals must focus on equity and on the most poor and marginalised. In particular, progress should be measured not just at the aggregate, national level, but data needs to be disaggregated by various factors including income, gender and ethnicity, to make inequities visible and allow better targeting of vulnerable groups.

A second flaw of the MDGs is the way they focus attention on a small  number of selected issues at the expense of others.  What are your chances if your problem isn’t on the list?  In all likelihood resources will be diverted away from your needs to address those included in the goals.  The MDGs have arguably had devastating consequences for massively important areas such as mental health, disability and non-communicable diseases.

Perhaps their biggest flaw of all is that the MDGs have concentrated almost exclusively on the symptoms of poverty, rather than addressing its causes.  It is vital that international development focuses on the reasons such extreme poverty and inequality exists in the first place.  If the global systems that sustain poverty, such as trade, financial markets, tax, and in general the global distribution of power, remain the same, then poverty too will remain – and future generations will continue to suffer.

As the goals come to an end and the world decides what comes next, we have a unique opportunity to improve on the international framework for development, to ensure the new framework works towards development for all.

One of the most inspiring things about human beings is our ability to learn from our mistakes, to grow and improve. As we debate what should come after the MDGs, we have a wonderful chance to work towards achieving a more equitable world.  We mustn’t fail to take it.

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About Martin Drewry

Director of Health Poverty Action
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